COVID-19 INFORMATION FOR MEMBERS
Revised Directive #2 (May 26, 2020)
Authorizes Gradual Restarting of Services
On May 26th, 2020 the Chief Medical Officer of Health amended Directive #2 to permit the gradual return to the delivery of non-urgent care. The revised Directive #2 states that, “All deferred and non-essential services carried out by Health Care Providers may be gradually restarted, subject to the requirements of this Directive.” It goes on to stress the need for Health Care Providers to consider a gradual restart of services, ensuring appropriate readiness, and that it is not expected that everyone will immediately return to full-service delivery.
The revised Directive requires that, “In the gradual restart of services, Health Care Providers must comply with the requirements as set out in COVID-19 Operational Requirements: Health Sector Restart (May 26, 2020 or as current) including, but not limited to, the hierarchy of hazard controls”. This document outlines safety measures to be in place for the provision of in-person health services by Health Care Providers.
Members are encouraged to review both the revised Directive #2 and the COVID-19 Operational Requirements: Health Sector Restart to ensure an understanding of relevant requirements in order to appropriately prepare for the return to in-person service provision.
While permitting the return to in-person service, the revised Directive expects that members will consider which services can continue to be provided remotely and which can be offered safely in-person, with appropriate infection control protocols and personal protective equipment (PPE) in place. It states that, “subject to the requirements of this revised Directive, Health Care Providers are in the best position to determine which services should continue to be provided remotely (online, by telephone or other virtual means) and which should be provided in-person.” This should be guided by best clinical evidence and adherence to any guidance provided by the College.
The College continues to recommend that when practical and clinically appropriate in keeping with client’s/patient’s best interest, members should provide services virtually rather than having clients/patients receive psychological services in-person.
Decisions about returning to in-person service should be made in accordance with the four principles set out and defined in Directive #2: Proportionality; Minimizing Harm to Patients; Equity; and Reciprocity.
In preparing for the gradual return of clients/patients to in-person service, members must remember the need for appropriate infection control protocols and PPE. Members should ensure they review, understand and implement the revised Directive #2 and the relevant sections of the COVID-19 Operational Requirements: Health Sector Restart. In addition, the College strongly recommends members consider the following information previously provided:
- Client/patient appointments should be scheduled to limit and, where possible, eliminate having people gather in waiting areas. Scheduling should provide for a time interval between the end of one appointment and the start of the next, and clients/patients should be asked to arrive as close to their appointment start time as possible. This will minimize the overlap of clients/patients in waiting areas.
- Seating in waiting areas should be spaced to maintain a physical distance of two metres. Note that people living in the same household are not required to maintain this separation. Members may wish to consider marking minimum distances with tape and, if the physical office space allows, arrange for one-way person traffic flow [i.e., in one door and out another with staff and clients/patients travelling one way in the same direction as much as possible]. This may not always be practical, but the objective is to minimize recurring contact.
- Members may wish to employ alternative solutions to having clients/patients waiting in the waiting room. This could include asking them to wait in their vehicles for a text message or telephone call when it is their appointment time.
- When appropriate, individuals accompanying clients/patients but not participating in the service, such as those providing transportation, should be asked to wait elsewhere and return to meet the client/patient after the appointment is scheduled to end.
- Inner office rooms should be furnished to allow physical distancing between members and clients/patients. If this is not possible, masks should be worn by all parties.
- A notice should be placed on the outer office door directing clients/patients and those accompanying them, to ‘self-screen’. If a client/patient or visitor has any of the symptoms noted, [i.e., fever, cough or difficulty breathing], or if they are feeling generally ill, they should not enter but should telephone the office. A sample Visitors Notice is available from the Ministry of Health in both English and French.
- When appointments are being booked, clients/patients should be asked if they have been experiencing symptoms of illness consistent with COVID-19; anyone who has symptoms should be offered a virtual visit or be scheduled for a later time.
- Clients/patients should be asked to self-screen or be screened by a member or staff for visible symptoms consistent with COVID-19. Appointments for anyone who is symptomatic should be cancelled.
- A daily log of everyone coming to the office, staff and visitors alike, should be kept in order to provide contact tracing should a case of COVID-19 be associated with your office. Arrival and departure times of each individual, including members themselves, should be recorded accurately and the log maintained.
- Non-essential items such as magazines and toys, etc., should be removed from client/patient waiting areas.
- Common areas and other high-touch surfaces and objects handled by clients/patients (e.g., reception counters, chairs and seating areas, door handles, handrails, credit card machines, washroom fixtures, etc.) be cleaned and disinfected after each use with a hard surface area cleaner approved by Health Canada.
- Assessment materials or other equipment or items handled by multiple clients/patients should be cleaned and disinfected after each use as above.
- Barriers to transmission (e.g., a physical barrier at reception, use of masks) should be considered and implemented where possible.
- Use of masks by staff and clients/patients should be considered generally and, in particular, in situations where adequate physical distancing is difficult.
- Members and support staff must practice effective hand hygiene after contact with each client/patient, washing their hands with soap and water or an alcohol-based hand sanitizer approved by Health Canada. It is important to ensure there are sufficient supplies on hand for proper hand hygiene, including pump soap, warm running water and paper towels or hot air dryers. Non-touch, lined waste disposal receptacles for use by both staff and clients/patients should be provided throughout your professional office.
- Additional visitors to the office, such as delivery persons, should be discouraged or scheduled after hours where possible. Delivery packages should be left at the entrance. Staff should be encouraged to bring meals from home, rather than going out and returning to the office at lunch or introducing additional individuals to the workplace [i.e., meal delivery services]. If the professional office is in a clinic setting, the use of common areas should be discouraged and minimized [i.e., kitchens] as should sharing of common utensils, plates and drinking cups.
- Wherever possible, members and staff should refrain from sharing phones, desks, offices and other tools and equipment. This may involve temporary reallocation of staff resources and job functions such that, rather than several people doing the same thing, one individual is responsible exclusively for each unique task.
- Minimize support staff physically in the office. To the extent possible, have support staff work from home, and equip them with the means to do so.
The Ministry of Health has provided a resource entitled, COVID-19 Guidance: Essential Workplaces. This document provides a variety of information, some of which may not be applicable to your office, but which was prepared to assist with the minimization of COVID-19 transmission in workplaces generally.
The College will continue to review recommendations from the Ministry and the Chief Medical Officer of Health and provided updates to the membership as appropriate.
Keep healthy and safe,
Rick Morris, Ph.D., C.Psych.
Registrar & Executive Director